Emergency Computed Tomography Imaging Assessment of the Neck Acute Conditions

Purpose: A detailed assessment of CT examinations of the neck soft tissues gives possibility for an accurate differential diagnosis based on the involvement of interfascial spaces and other radiological signs, radiological-clinical combined signs of neck pathological changes if tailored CT examination protocol in emergency department is applied. Methods and materials: 1. Retrospectively patients were analysed with emergency CT imaging in „Pauls Stradins Clinical University Hospital” in years of 2018 and 2019 for neck pathologies, their locations, characteristic radiological signs, changes in neck lymph nodes (location, changes which describe specific, non-specific lymph nodes), other radiological methods and also laboratory data correlation. 2. Additionally was evaluated patient clinical symptoms, documentation, otolaryngologist findings, used treatment (medical, surgical), histological and cytological findings, if they were performed. 3. Retrospectively was analysed CT role in case of emergency imaging and the correlation with clinical data and laboratory changes. 4.Examination protocol: CT topogram without contrast in axial plane from nose till aortic bifurcation. One post contrast examination was performed with an aim to reduce the radiation dose for the patient. To exclude vascular injury or to differentiate inflammatory and oncology changes - arterial, venous and delayed post contrast examination was performed. Results: Neck soft tissue pathology was found in 175/208 cases: 90 cases inflammatory changes, 48 cases oncology, 14 cases trauma and 18 cases other pathology, for example congenital pathology. Most cases showed involvement above os hyoideum - pharyngeal space (n=100), parapharyngeal space (n=81), parotid (n=28), masticator (n=21), less often retropharyngeal (n=18), carotid, (n=17), perivertebral (n=4) and posterior cervical space (n=2). Conclusion: 1.CT examination of the soft cervical tissue at the emergency early stage is available and fast to determine the type of pathology, prevalence, complications and subsequent planning of treatment tactics, especially in 3 major groups of pathologies – tumors, inflammation and trauma. 2. In the evaluation of soft cervical tissues in patients with clinical suspicion of oncology - contrast-enhanced 3-series CT protocol is advised to assess the extension and vascularization characteristics, in inflammatory and other benign cases non-enhanced CT and 100th enhanced second examination is informative, while reducing the radiation dose for the patient. 3. In order to accurately assess pathological changes in the neck, it is important to determine its localization in the interfascial spaces for treatment planning, but this does not narrow the radiological differential diagnosis. It is recommended to take into account the age of the patient, allowing to narrow the differentials, i.e. tumours were more observed after 45 years, while injuries up to 65 years, but inflammation affects all age groups without significant differences. Irregular shape, heterogeneous, with cystic degeneration or necrosis after contrast administration and slow course - with high probability are associated with oncology, while short history, rapid progression and alterated laboratory and other test results - in the case of inflammation. Particular attention should be paid to blood C reactive protein levels > 125 mg/l, which indicates abscess formation in the throat and parapharyngeal space, while in case of tumour and injury not reaching 50 mg/l.